HbA1c testing in barbershops identified black men with undiagnosed diabetes

About one-third of men approached in barbershops owned by black individuals were willing to be screened for diabetes, and 9% of them had undiagnosed diabetes while 28% had prediabetes.

Point-of-care HbA1c testing in community barbershops may help identify black men who need care for their undiagnosed diabetes or prediabetes, a study found.

From Sept. 19, 2017, to Jan. 23, 2019, researchers approached and tested customers at eight Brooklyn barbershops owned by black individuals in neighborhoods previously identified as having a high prevalence of poor glycemic control. English-speaking black men ages 18 years and older without a history of diabetes were included in the study. To avoid obtaining spurious HbA1c readings, individuals with blood disorders (e.g., sickle cell disease) and those who had recently experienced blood loss were excluded. Test results were provided within five minutes.

Participants with an HbA1c level of 6.5% or higher on a single test result were considered to have diabetes; however, a confirmatory test was not performed. Those with an abnormal HbA1c result (≥5.7%) received counseling about the importance of modifying their diet and physical activity and the need for medical management, as well as received contact information for local primary care clinics. Results were published in a research letter on Jan. 27 by JAMA Internal Medicine.

Of 895 black men who were asked to participate, 312 (34.9%) agreed to be screened, and 290 (32.4%) were successfully tested. Eight men were excluded due to blood disorder, and 14 had an error code during their testing and declined a second test to resolve the code. Of the 583 men who declined to participate, 331 (56.8%) provided a reason for doing so. One hundred eighty-seven (56.5%) reported already knowing their health status or having been checked by their doctor; 117 (35.3%) reported either being healthy, not having the time or interest, or not wanting to know their result; and 26 (7.9%) reported being scared of needles. Only one man specifically reported not wanting to be tested in a barbershop.

Of the 290 tested participants (54.5% under age 40 years; mean body mass index, 29.3 kg/m2), 26 (9.0%) had undiagnosed diabetes, three of whom had an HbA1c level of 7.5% or higher. In addition, 82 (28.3%) had prediabetes (HbA1c level between 5.7% and 6.4%). Of the 26 men with undiagnosed diabetes, 16 (61.5%) were obese, the median age was 41 years (range, 22 to 65 years), and 11 (42.3%) had a high school education or less.

Anecdotally, some customers who initially declined testing subsequently agreed after encouragement from their barber, the authors noted. “Our findings suggest that community-based diabetes screening in barbershops owned by black individuals may play a role in the timely diagnosis of diabetes and may help to identify black men who need appropriate care for their newly diagnosed diabetes,” the authors concluded.

Among other limitations, participation rates may not be generalizable to other community-based settings or other areas of New York City or the U.S., and the study sample may not be representative of other barbershops, they said.